Part 1/3: Connect the Whole Body & Optimize Performance with The Thoracic Ring Approach

The Thoracic Ring Approach offers an innovative, unique perspective on the function of thoracic spine and ribcage (the thorax) and the role that the thorax plays in optimal function of the whole body and optimal health of the whole person. This approach was created and developed by founder Linda-Joy (LJ) Lee.

Historically, clinicians have assessed the function of the thoracic spine separately from the function of the ribs, and techniques have focused on determining motion and integrity of the articular structures (facet or zygapophyseal joints, costotransverse joints, costochondral joints, sternocostal joints), with a focus on posterior palpation. Based on anatomical and biomechanical data, LJ has proposed that the most accurate evaluation of function in the thorax is based on understanding that the functional spinal unit in the thorax is the "thoracic ring" where there are anterior attachments to the sternum (usually 1st to 10th rings).

The "thoracic ring" consists of two adjacent vertebrae and the related intervertebral disc, the right and left ribs (attached to the vertebra-disc-vertebra complex at the costovertebral joints), and the anterior attachments to the sternum/ manubrium and related cartilages. So the "5th thoracic ring" is defined as the T4-5 vertebral segment and disc, the right and left 5th ribs, and the anterior attachments of the 5th rib to the sternum (Lee, D).

Since the late 1990's, LJ has developed a range of manual techniques to assess and treat the thoracic ring as an integrated three-dimensional complex, including specific exercises to train motor control of the thoracic ring. Movement and control of the thoracic rings is palpated laterally, at the sides of the ribs in the axilla, which is farthest away from the axis of rotation of the ring. It is LJ's proposal that position, movement, and control determined from this palpation at the side of the ribs (of the same thoracic level) reflects the behaviour of the structures of the entire thoracic ring (and therefore the vertebral motion and rib motion).

A powerful aspect of the approach is the clinical reasoning framework LJ created that provides the ability to determine when the thoracic rings are the "primary driver" or true underlying problem, of the person's problem related to their Meaningful Task. This is essential because it is common for the thorax to be relatively pain-free but dysfunctional; the dysfunctional thorax creates adverse stresses, loads and forces that can cause pain in any other area of the body. If the thoracic rings are determined to be behaving non-optimally for the task, optimal movement and control of the thoracic rings is manually facilitated with LJ's "ring correction" techniques, and the impact of these corrections on the patient's meaningful task performance, pain experience, and function of the rest of the body is assessed. 

Another paradigm-shifting tenant of The Thoracic Ring Approach is the proposal that the most common underlying impairment of the thorax is one of non-optimal neuromuscular control, and not true joint stiffness.

It is time to let go of the myth that the thoracic spine is inherently stiff and stable due to the presence of the ribcage.

There are many different problems that can be "driven" by a non-optimal thorax, and LJ has proposed multiple mechanisms to explain how the thorax can be the true underlying problem for such a variety of conditions. 

LJ teaches the Thoracic Ring Approach around the world. The Thoracic Ring Approach techniques have also become part of the whole person Integrated Systems Model (ISM) developed by LJ Lee and Diane Lee (2007).